Healthcare Provider Details

I. General information

NPI: 1275313454
Provider Name (Legal Business Name): K FIT PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4857 GOODMAN RD STE 106
OLIVE BRANCH MS
38654-7916
US

IV. Provider business mailing address

5902 CORINTH WAY
SOUTHAVEN MS
38672-7046
US

V. Phone/Fax

Practice location:
  • Phone: 601-750-7252
  • Fax:
Mailing address:
  • Phone: 601-750-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRA S FITCHPATRICK
Title or Position: OWNER
Credential: PT, DPT
Phone: 601-750-7252